Doctors Without Borders say help, coordination desperately needed

International response to the West African Ebola outbreak has been "chaotic and entirely inadequate," according to a statement issued Wednesday by the humanitarian group Doctors Without Borders, which has been treating patients in affected countries for months.

Doctors Without Borders' newest Ebola treatment facility — a 120-bed facility in Monrovia, the capital of Liberia — is already overwhelmed. The group plans to construct three additional tents with space for 40 more beds.

Doctors Without Borders' guidelines were written for Ebola treatment centers with just 20 beds. "We have to constantly adapt" to address a crisis of this scale, Lindis Hurum, the group's emergency coordinator in Monrovia, said in a statement. "The numbers of patients we are seeing is unlike anything we've seen in previous outbreaks," Hurum said.

The new treatment center can slow the spread of the outbreak by isolating patients, preventing them from infecting friends and family. But overworked health workers have had to reduce the level of care they provide, according to Doctors Without Borders. They can no longer administer intravenous treatments, for example, which could limit doctors' ability to help dehydrated patients.

"It is simply unacceptable that, five months after the declaration of this Ebola outbreak, serious discussions are only starting now about international leadership and coordination," said Brice de le Vingne, director of operations at Doctors Without Borders. Referring to other countries that have the potential to help, he says, "They can do more, so why don't they?"

In Monrovia, "much of the city's medical system has shut down over fears of the virus among staff members and patients, leaving many people with no health care at all, generating an emergency within the emergency," the group's statement says. Women have trouble finding places to deliver babies, for example.

According to the World Health Organization, Ebola has infected more than 2,600 people and killed more than 1,400 in the four affected countries – Guinea, Sierra Leone, Liberia and Nigeria.

A separate Ebola outbreak has been reported in the Democratic Republic of Congo but appears unrelated.

A number of aid agencies are trying to help.

The United Nations Children's Fund (UNICEF) airlifted 168 tons of health and hygiene supplies to Liberia in the past week.

The aid group AmeriCares sent a shipment of antibiotics, medical supplies and "desperately needed safety equipment," the group says, including 15,000 pairs of gloves and nearly 10,000 protective masks. Getting to West Africa has become more difficult as airlines have canceled flights because of the epidemic. One of AmeriCares' five shipments was delayed after a shipping company refused to go to Sierra Leone, says Garrett Ingoglia, AmeriCares' vice president of emergency response. The group chartered its own plane to get around these difficulties.

In a bleak assessment in The New England Journal of Medicine, nurse Anja Wolz wrote, "We need to be one step ahead of this outbreak, but right now, we are five steps behind."

In the Kailahun district in Sierra Leone, where Wolz works as the emergency coordinator for Doctors Without Borders, there are four ambulances for a region of 470,000 people.

Providing basic care is difficult, Wolz wrote, noting that the process of putting on personal protective equipment – or PPE, the full-body moon suits" needed to prevent infection with Ebola – takes five minutes. A "designated dresser" has the sole job of making sure health workers are properly protected and "not a square millimeter of skin is exposed."

These measures are critical, given that more than 120 of 240 health workers infected with Ebola have died, according to WHO reports.

Health workers can wear the bulky suits for no more than 40 minutes at a time to avoid overheating in the tropical climate, Wolz wrote. Though durable equipment such as boots can be sterilized and reused, most other clothing is burned.

Wolz described the difficulty of comforting a pair of young siblings whose parents, grandmother and caregiver died from Ebola: "When the boy died, we tried to console and calm his sister, but the PPE made it difficult to touch her, to hold her, even to speak with her. She died the next day."